1
|
Hoeper JR, Schuch F, Steffens-Korbanka P, Gauler G, Welcker M, Wendler J, von Hinüber U, Meyer SE, Schwarting A, Zeidler J, Witte T, Meyer-Olson D, Hoeper K. [Delegation of medical duties to qualified rheumatology assistants : Effect on depression and anxiety in patients with rheumatoid arthritis]. Z Rheumatol 2024; 83:407-415. [PMID: 37648932 PMCID: PMC11147826 DOI: 10.1007/s00393-023-01403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND At least 1 comorbidity occurs in 80% of patients with rheumatoid arthritis (RA). In addition to cardiovascular comorbidities psychological comorbid conditions are common. The prevalence of depression and anxiety is higher in patients than in the general population. Screening for comorbidities is crucial. A shortage of outpatient specialist care barely allows resources for this. The implementation of team-based care holds the potential to improve the standard of care while simultaneously working against the shortage of care. OBJECTIVE The aim of the study was to examine the effects of care on the course of depression and anxiety in patients with seropositive RA and active disease. MATERIAL AND METHODS A multicenter pragmatic randomized controlled trial was conducted over the course of 1 year with 224 patients. After baseline, five more visits followed. In the intervention group (IG), three were initially carried out by qualified rheumatological assistants. Depression, anxiety and patient satisfaction with outpatient care were looked at in detail. RESULTS In the IG the anxiety symptoms significantly improved over 12 months (p = 0.036). The proportions of patients with anxiety also significantly changed in the IG (p < 0.001), while there was no change in the control group between baseline and month 12. The values of the depression scale did not differ significantly (p = 0.866). In terms of the information dimension of the satisfaction questionnaire, patients in the IG felt significantly better informed after 6 months (p = 0.013) and 12 months (p = 0.003). CONCLUSION A positive effect of team-based care on the course of depression and anxiety in patients with seropositive RA and active disease could be shown.
Collapse
Affiliation(s)
- Juliana Rachel Hoeper
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Deutschland
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
| | - Florian Schuch
- Rheumatologie, Internistische Praxisgemeinschaft, Erlangen, Deutschland
| | | | - Georg Gauler
- Rheumapraxis an der Hase, Osnabrück, Deutschland
| | | | - Jörg Wendler
- Rheumatologie, Internistische Praxisgemeinschaft, Erlangen, Deutschland
| | | | - Sara Eileen Meyer
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
| | - Andreas Schwarting
- Klinik für Rheumatologie und klinische Immunologie, Universitätsmedizin Mainz, Mainz, Deutschland
- ACURA Kliniken Rheuma-Akutzentrum Rheinland-Pfalz, Bad Kreuznach, Deutschland
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Deutschland
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
| | - Dirk Meyer-Olson
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
- Rheumatologie, m&i Fachklinik Bad Pyrmont, Bad Pyrmont, Deutschland
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
| |
Collapse
|
2
|
Fuchs F, Morf H, Mohn J, Mühlensiepen F, Ignatyev Y, Bohr D, Araujo E, Bergmann C, Simon D, Kleyer A, Vorbrüggen W, Ramming A, Distler JHW, Bartz-Bazzanella P, Schett G, Welcker M, Hueber AJ, Knitza J. Diagnostic delay stages and pre-diagnostic treatment in patients with suspected rheumatic diseases before special care consultation: results of a multicenter-based study. Rheumatol Int 2023; 43:495-502. [PMID: 36214864 PMCID: PMC9968271 DOI: 10.1007/s00296-022-05223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
Early and effective discrimination (triage) of patients with inflammatory rheumatic diseases (IRD) and other diseases (non-IRD) is essential for successful treatment and preventing damage. The aim of this study was to investigate diagnostic delays and pre-diagnosis treatment in patients newly presenting to rheumatology outpatient clinics. A total of 600 patients newly presenting to one university hospital and two non-academic centers were included. Time from onset of symptoms to rheumatology consultation "total delay" as well as medical treatment before consultation were recorded. Median time from symptom onset to rheumatologist appointment (total delay) was 30 weeks. Median time to online search, first physician appointment request and first physician appointment was 2, 4 and 5 weeks, respectively. Total delay was significantly shorter for IRD patients compared to non-IRD patients, 26 vs 35 weeks (p = 0.007). Only 17.7% of all patients and 22.9% of IRD patients had a delay of less than 12 weeks. Total delay was significantly lower in patients seen in non-academic centers compared to the university center, 20 vs 50 weeks (p < 0.0001). 32.2% of IRD patients received medical treatment that eased their symptoms prior to the rheumatology appointment. These findings highlight the persistent diagnostic delays in rheumatology; however, they also suggest that current triage strategies effectively lead to earlier appointments for IRD patients. Improvement of triage methods and pre-diagnosis treatment could decrease overall burden of disease in IRD patients.
Collapse
Affiliation(s)
- Franziska Fuchs
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Harriet Morf
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jacob Mohn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Felix Mühlensiepen
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Neuruppin, Germany
| | - Yuriy Ignatyev
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Neuruppin, Germany
| | - Daniela Bohr
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Elizabeth Araujo
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wolfgang Vorbrüggen
- Verein Zur Förderung Der Rheumatologie E.V, Würselen, Germany.,RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter Bartz-Bazzanella
- RheumaDatenRhePort (rhadar), Planegg, Germany.,Klinik Für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Welcker
- Klinik Für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany.,MVZ Für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
| | - Axel J Hueber
- Division of Rheumatology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany.,Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. .,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
| |
Collapse
|
3
|
Gall S, Kiltz U, Kobylinski T, Andreica I, Vaupel K, Waldecker C, Baraliakos X, Braun J. Patient knowledge about biosimilars and satisfaction with the education provided by rheumatologists or nurse specialists in a biosimilar multiswitch scenario – The perception study. Semin Arthritis Rheum 2022; 57:152119. [DOI: 10.1016/j.semarthrit.2022.152119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
|
4
|
Krause* D, Mai* A, Denz R, Johow J, Reese JP, Westerhoff B, Klaaßen-Mielke R, Timmesfeld N, Rittstieg A, Saracbasi-Zender E, Günzel J, Klink C, Schmitz E, Fendler C, Raub W, Böddeker S, Dybowski F, Hübner G, Menne HJ, Lakomek HJ, Sarholz M, Trampisch U, J. Trampisch H, Braun J. The Structured Delegation of Medical Care Services for Patients With Inflammatory Rheumatic Diseases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:157-164. [PMID: 35101166 PMCID: PMC9215273 DOI: 10.3238/arztebl.m2022.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In some areas of Germany, there is a shortage of specialist physicians for patients with inflammatory rheumatic diseases. Delegating certain medical care services to qualified, specialized rheumatological assistants (SRAs) might be an effective way to supplement the available capacity for specialized medical care. METHODS Patients under stable treatment for rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were included in this trial, which was designed to demonstrate, in a first step, the non-inferiority of a form of care involving delegation of physicians' tasks to SRAs (team-based care), in comparison to standard care, with respect to changes in disease activity at one year. "Non-inferiority," in this context, means either superiority or else an irrelevant extent of inferiority. In a second step, in case non-inferiority could be shown, the superiority of team-based care with respect to changes in patients' health-related quality of life would be tested as well. Disease activity was measured with the Disease Activity Score 28, and health-related quality of life with the EQ-5D-5L. This was a randomized, multicenter, rater-blinded trial with two treatment arms (team-based care and standard care). The statistical analysis was performed with mixed linear models (DRKS00015526). RESULTS From September 2018 to June 2019, 601 patients from 14 rheumatological practices and 3 outpatient rheumatological clinics in the German states of North Rhine-Westphalia and Lower Saxony were randomized to either team-based or standard care. Team-based care was found to be non-inferior to standard care with respect to changes in disease activity (adjusted difference = -0.19; 95% confidence interval [-0.36; -0.02]; p <0.001 for non-inferiority). Superiority with respect to health-related quality of life was not demonstrated (adjusted difference = 0.02 [-0.02; 0.05], p = 0.285). CONCLUSION Team-based care, with greater integration of SRAs, is just as good as standard care in important respects. Trained SRAs can effectively support rheumatologists in the care of stable patients with RA or PsA.
Collapse
Affiliation(s)
- Dietmar Krause*
- *The authors contributed equally to this paper
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Anna Mai*
- *The authors contributed equally to this paper
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Robin Denz
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Johannes Johow
- Coordination Center for Clinical Trials of Philipps University Marburg
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, Julius Maximilian University Würzburg
| | | | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Annette Rittstieg
- *The authors contributed equally to this paper
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | | | - Judith Günzel
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Claudia Klink
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Elmar Schmitz
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Claas Fendler
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Wolf Raub
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Stephanie Böddeker
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Friedrich Dybowski
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Georg Hübner
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Hans-Jürgen Menne
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Heinz-Jürgen Lakomek
- Johannes Wesling Minden Hospital, Germany, Department of Rheumatology and Physical Medicine
| | | | - Ulrike Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Hans J. Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Jürgen Braun
- The Ruhr District Rheumatology Center, Ruhr University Bochum
| |
Collapse
|
5
|
Hospach T, Horneff G, Poddubnyy D. [Spondyloarthritis in childhood and adulthood]. Z Rheumatol 2022; 81:14-21. [PMID: 34985566 DOI: 10.1007/s00393-021-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Axial spondylarthritis in adulthood (SpAA) is frequently initially manifested as a sacroiliitis, whereas this not true for enthesitis-related arthritis (EAA), which begins in childhood and adolescence. Classically, EAA begins with peripheral arthritis and only a part transitions into a juvenile SpA (jSpA) or SpAA. The criteria used for classification of SpAA and EAA are currently being validated and revised. For the first time imaging is included for EAA. For both diseases nonsteroidal anti-inflammatory drugs (NSAID) are initially used therapeutically, followed by biologicals or synthetic targeted disease-modifying drugs in refractory courses. Steroids should be avoided in long-term treatment. For optimal transition and further care in adulthood, a close cooperation between internistic and pediatric rheumatologists is necessary.
Collapse
Affiliation(s)
- Toni Hospach
- Zentrum für pädiatrische Rheumatologie, am Klinikum Stuttgart (ZEPRAS), Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - Gerd Horneff
- Rheumazentrum für Kinder und Jugendliche, St. Augustin, Deutschland
| | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité, Berlin, Deutschland
| |
Collapse
|
6
|
Kuhlmann E, Bruns L, Hoeper K, Richter M, Witte T, Ernst D, Jablonka A. Work situation of rheumatologists and residents in times of COVID-19 : Findings from a survey in Germany. Z Rheumatol 2021; 82:331-341. [PMID: 34535820 PMCID: PMC8448391 DOI: 10.1007/s00393-021-01081-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
Background and objective The work situation is an important dimension of professional life and wellbeing, and a policy lever to strengthen recruitment and retention. This study aims to explore the work situation of physicians and residents in internal medical rheumatology, considering the impact of the coronavirus pandemic COVID-19. Methods A questionnaire-based online survey was conducted in early 2021 at the Hannover Medical School, supported by the German Society of Rheumatology. Target groups were all rheumatology physicians and residents in Germany. The main areas of investigation included work hours, task delegation, and collaboration; workload and mental health issues; discrimination and sexual harassment experiences; and the impact of COVID-19. Descriptive statistical analysis was performed for the standardized items and qualitative content analysis for the free-text information. Results The respondents (n = 101) expressed positive attitudes towards cooperation and task delegation to medical assistants, especially those specialized in rheumatology, while attitudes towards cooperation with GPs pointed to blockades. There was a strong mismatch between actual and desired work hours both in the group of women and in the group of men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress, with major stressors being digitalization and increased demand for communication and patient education. Conclusion There is an urgent need to improve the work situation of rheumatologists and reduce stress and mental health risks. Supplementary Information The online version of this article (10.1007/s00393-021-01081-5) includes the survey questionnaire in German.
Collapse
Affiliation(s)
- Ellen Kuhlmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Luzia Bruns
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover , Germany
| | - Marianne Richter
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover , Germany
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| |
Collapse
|